Enzymes

Raised Levels
*most significant finding
- increased synthesis/cell proliferation
- cell membrane damage
- cell death
- defective/slow blood clearance
Level increased can = extent of injury
Isoenzyme = greater tiss specificity

Enzyme profiles

1) tissue of origin
2) isoenz pattern in tiss
3) timing in relation to disease
4) lab availability

Normal variations of enzyme levels

1) Age/sex variation in reference range (ALP higher in adolescents)
2) Race (CK higher in afro-Caribbean)
3) Analytical interference (transaminases & LDH - haemolysis from red cells)
4) Renal failure (Amylase increased, as excreted renal-ly)
5) 'Macro enzymes' - binding of enzyme to immunoglobulin - lowers rate of degradation
- primary protein (immunoglobulin) disease eg myeloma
- temp
- *CK & AMY
- = req alt of Ix w/ documentation

Dx

MI
CK & CK-MB
troponin (non-enzyme)

x transamimases/LDH

Liver
ALT
ALP
GGT

Pancreatitis
Amy

Skeletal

CK for muscles
ALP for bone